MELD 3.0 is a more accurate predictor of mortality in decompensated cirrhosis than MELD and MELD-Na
DOI:
https://doi.org/10.62438/tunismed.v104i04.5938Keywords:
Cirrhosis, Prognosis, mortality, Liver transplanationAbstract
Backgroud and aim: Prognostic scores guide organ allocation in cirrhosis.We assessed the performance of MELD, MELD-Na, and MELD 3.0 for predicting mortality in decompensated Tunisian cirrhotic patients
Methods: We conducted a retrospective study including decompensated cirrhosis patients in a Tunisian gastroenterology department.
Results: 152 patients were enrolled (mean age 61 years; viral etiology 65.1%). Mean MELD-Na and MELD 3.0 were 17.7 and 19.4. Mean follow-up: 17.1 months. Decompensation rate: 33.6%; 3-month mortality: 18.4%. For 3-month mortality, AUROCs were 0.786 (MELD), 0.841 (MELD-Na), and 0.850 (MELD 3.0). MELD 3.0 cut-off of 24 yielded sensitivity 68%,
specificity 88% (p=0.04 for association with mortality).
Conclusion: MELD 3.0 outperformed MELD and MELD-Na in predicting mortality. A MELD 3.0 score ≥24 identifies patients who should be prioritized
on the transplant waiting list.
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References
Polyak A, Kuo A, Sundaram V. Evolution of liver transplant organ allocation policy: Current limitations and future directions. World J
Hepatol. 27 août 2021;13(8):830 9
Nagai S.Chau L.C.Schilke R.E.et al.Effects of allocating livers for transplantation based on Model for End-Stage Liver Disease-
Sodium scores on patient outcomes.Gastroenterology. 2018; 155: 1451-1462
Kim WR, Mannalithara A, Heimbach JK, Kamath PS, Asrani SK, Biggins SW, Wood NL et al. MELD 3.0: The Model for End-stage Liver
Disease Updated for the Modern Era. Gastroenterology, 2021.
Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, et al. The global, regional, and national burden of cirrhosis by cause
in 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet Gastroenterol
Hepatol. 2020 Mar;5(3):245-66.
Karoui S, Hamzaoui S, Sahli F, Matri S, Boubaker J, Filali F. Mortalité au cours des cirrhoses: prévalence, causes et facteurs prédictifs.
Tunis Med 2002;80:21-5
Conn HO. A peek at the child-turcotte classification. Hepatology. 1981 Nov;1(6):673-6.
Boursier J, Cesbron E, Tropet AL, Pilette C. Comparison and improvement of MELD and child-pugh score accuracies for the
prediction of 6-month
Schiff ER, Maddrey WC, Sorrell MF. Schiff’s Diseases of the Liver. John Wiley & Sons; 2011
Godfrey EL, Malik TH, Lai JC, et al. The decreasing predictive power of MELD in an era of changing etiology of liver disease. Am J
Transplant 2019;19:3299–3307.
Biggins SW, Rodriguez HJ, Bacchetti P, Bass NM, Roberts JP, Terrault NA. Serum sodium predicts mortality in patients listed for liver
transplantation. Hepatology. janv 2005;41(1):32-9.
Wu SL, Zheng YX, Tian ZW, Chen MS, Tan HZ. Scoring systems for prediction of mortality in decompensated liver cirrhosis:
A meta-analysis of test accuracy. World J Clin Cases. 6 déc 2018;6(15):995-1006.
Locke JE, Shelton BA, Olthoff KM, Pomfret EA, Forde KA, Sawinski D, Gray M et al. Quantifying Sex- Based Disparities in Liver Allocation.
JAMA Surg, 2020, 155:e201129.
Allen AM, Heimbach JK, Larson JJ, Mara KC, Kim WR, Kamath PS, Therneau TM. Reduced Access to Liver Transplantation in Women:
Role of Height, MELD Exception Scores, and Renal Function Underestimation. Transplantation, 2018, 102:1710–1716.
Kim WR, Mannalithara A, Heimbach JK, Kamath PS, Asrani SK, Biggins SWand al. MELD 3.0: The Model for End-Stage Liver Disease
Updated for the Modern Era. Gastroenterology. 2021;161(6):1887- 1895.e4.
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